Hepatic lobes

The 3 10 cells in the liver—particularly the hepatocytes, which make up 90% of the cell mass—are the central location for the body s intermediary metabolism. They are in close contact with the blood, which enters the liver from the portal vein and the hepatic arteries, flows through capillary vessels known as sinusoids, and is collected again in the central veins of the hepatic lobes. Hepatocytes are particularly rich in endoplasmic reticulum, as they carry out intensive protein and lipid synthesis. The cytoplasm contains granules of insoluble glycogen. Between the hepatocytes, there are bile capillaries through which bile components are excreted. 

Nakao, K., Iwata, M. Hypogenesis of right hepatic lobe accompanied by portal hypertension case report and review of 31 Japanese cases. J. Gastroenterol. 1997 32 836-842... 

Fig. 37.1 Grey-coloured, medium-coarse tubercular cirrhosis in haemochromatosis with hepatocellular carcinoma in the foreground, white, flat tumour granuloma of the right hepatic lobe with vascularization at the tumour margin and small cancer umbilicus in the background, two additional tumour granulomas. Carcinomas infiltrating the peritoneal serosa in the right upper abdomen...

Fig. 37.2 Liver metastases in the right hepatic lobe in breast cancer with pronounced chaotic vascularization. Dissipated light reflex due to tumourous tubercles on the surface...

Fig. 37.16 Large metastasis in the right hepatic lobe with distinct cancer umbilicus subsequent to breast cancer (serosa, peritoneum and ligaments without pathological findings)...

Definition A liver resection is defined as the surgical removal of tissue components of the liver in order to eliminate a localized disease process. The left hepatic lobe (segment I-IV) contains 40% and the right lobe (segment V-VIII) contains 60% of the total liver mass. (s. fig. 40.4) Removal of > 80% of a healthy liver is (in principle) fatal. Hyperplasia of the remaining liver can be expected, while regeneration of the resected portion of the liver is also possible. 

A 39-year-old woman with an unremarkable medical history underwent deep body massage, including the abdomen. Within 24 hours she experienced discomfort and nausea and after 72 hours she had a CT scan, which showed a large hematoma in the right hepatic lobe. There was no evidence of a plausible cause for this. In spite of adequate medical treatment, her recovery was slow and she had nausea and low-grade fever for about 6 months. 

Fig.4.12a-c. Metastatic lesions. a,bMRI showing multiple bright intensity lesions in a patient with metastatic lymphoma, c CT showing metastatic lesion in the right hepatic lobe... 

Fig. 7.4a,b. This figure illustrates an example of a software package for selecting anatomical landmarks in both anatomic (MRI) and physiologic studies, a Selection of the most lateral point of the left hepatic lobe, b The landmark placed in a caudal-anterior location of the right hepatic lobe... 

Group IV patients are not candidates for SIRT. Only in cases of diffuse unilobar disease, with homogeneous MAA uptake in the tumoral and non-tumoral tissue, and good function of the healthy hepatic lobe, can radiospheres treatment be considered as a therapeutic alternative. As in group III cases, we have to reach the decision about whether or not to treat the patient by consensus. All the risks have to be evaluated and a precise calculation of the expected residual liver function after the treatment has to be made, since this non-selective internal radiation therapy of a whole lobe could be considered as a radioactive lobectomy . 

Fig. 10.3. Partial response to RE in a patients with a large HCC. Scans were obtained before and 6 months after performing RE of the right hepatic lobe...

Cirrhotic changes within the liver in patients who are candidates for OLT or interventional treatment for HCC can be demonstrated by means of 3D-CT and MR angiography liver atrophy, nodularity, reduced size of right hepatic lobe and enlargement of the left hepatic lobe or caudate lobe (Smith et al. 1998). 

Intrahepatic collateral pathways can develop in cirrhotic patients with portal hypertension. Park et al. (1990) classified them in 4 types type 1 when there is a vessel of large diameter that connects the right portal branch with the inferior vena cava type 2 when there are one or more communications between the portal vein and hepatic veins in one hepatic segment type 3 when there is an aneurysmatic shunt between peripheral branches of the portal vein and hepatic veins type 4 when there are multiple communications between portal peripheral branches and hepatic vein branches in both hepatic lobes. 

Wang ZJ, Yeh BM, Roberts JP et al (2005) Living donor candidates for right hepatic lobe transplantation evaluation at CT cholangiography - initial experience. Radiology... 

Nagino M, Nimura Y, Kamiya J et al. (1995) Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization. Hepatology 21 434-439... 

Fig. 13.22. A 62 year old man, 4 weeks after gastrectomy, presenting with fever, tachycardia and abdominal pain. Upper GI series revealed a leak of the oesophagojejunal anastomosis. The extravasation extends along the lower border of the left hepatic lobe (thin arrow) to a round structure measuring several centimeters (thick arrow). Within the structure, there is an air/fluid level and a level between the contrast material and secretions. CT and subsequent surgery confirmed a subhepatic abscess. The leak was oversewn...

Fig.7.14a,b. Biloma in a 37-year-old woman with chronic stenosis of the main hepatic artery, fever, a Sonographic axial image on the left hepatic lobe shows two anechoic round lesions communicating with the dilated biliary tree, b Axial contrast-enhanced CT image shows two hypodense well-defined round lesions, communicating with the biliary tree... 

Fig. 9.3. a Conventional transverse US scan through the left hepatic lobe shows an isoechoic solid lesion barely differentiating from the surrounding liver, b Power Doppler US scan shows a typical spoke-wheel pattern, determined by vessels radiating from a vascularized central area, c Doppler spectral analysis of one of these radiating vessels shows the presence r of pulsatile waveform with high diastolic flow... 

Fig. 9.5. a Conventional oblique subcostal US scan through the right hepatic lobe shows an isoechoic rounded lesion (arrows). b Contrast-enhanced US scan obtained at the same time with both color Doppler mode and non-linear contrast specific mode color Doppler shows the macrocirculation of the lesion due to the central artery and some radiating vessels (arrowheads) and the microcirculation depicted during the portal phase... 

Paulson EK, Baker ME, Spritzer CE, et al (1993) Focal fatty infiltration a cause of nontumorous defects in the left hepatic lobe during CT arterial portography. J Comput Assist Tomogr 17 590-595... 

---